Ebook Perioperative management in robotic surgery: Part 2
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Ebook Perioperative management in robotic surgery: Part 2
ChapterRobotics in Thoracic Surgery 2Benign and Malignant Esophageal DiseaseFarid GharagozlooENDOSCOPIC ROBOTIC ESOPHAGECTOMYHistorical Background“The Ebook Perioperative management in robotic surgery: Part 2e history of esophageal surgery is a tale of men repeatedly losing to a stronger adversary yet persisting in this unequal struggle until the nature of the problems became apparent and the war was won.”A discussion on robotic esophagectomy is appropriately prefaced by this quote by Emslie, which prov Ebook Perioperative management in robotic surgery: Part 2ides the most accurate perspective for the struggle of surgeons with this elusive organ (1).The anatomic remoteness of the esophagus, along with the mEbook Perioperative management in robotic surgery: Part 2
any challenges of intraoperative management, have dictated the approach to esophagectomy through the ages. Galen described the patient with esophagealChapterRobotics in Thoracic Surgery 2Benign and Malignant Esophageal DiseaseFarid GharagozlooENDOSCOPIC ROBOTIC ESOPHAGECTOMYHistorical Background“The Ebook Perioperative management in robotic surgery: Part 2ry of the esophagus was first recorded by the Egyptians in 2500 BC with “repair of the gullet,” the first successful resection of cervical esophageal cancer was performed by Czerny in 1877 (3). This work was predicated on Billroth’s work in 1871 who demonstrated the feasibility of resection and re-a Ebook Perioperative management in robotic surgery: Part 2nastomosis of the cervical esophagus in an animal model (4). However, it was six decades later that a successful esophageal resection with intrathoracEbook Perioperative management in robotic surgery: Part 2
ic anastomosis was performed (5).In 1913, Torek performed the resection of a squamous cell carcinoma (SCCA) of the thoracic esophagus through the leftChapterRobotics in Thoracic Surgery 2Benign and Malignant Esophageal DiseaseFarid GharagozlooENDOSCOPIC ROBOTIC ESOPHAGECTOMYHistorical Background“The Ebook Perioperative management in robotic surgery: Part 2ed 13 years. For the first decades of the twentieth century, many techniques for the establishment of continuity of the alimentary tract were investigated. In 1911, Kelling described the use of colon for esophageal replacement (7). The use of stomach,based on the right gastroepiploic artery and the Ebook Perioperative management in robotic surgery: Part 2right gastric artery, was first demonstrated in the laboratory by Kirschner in 1920 (8). In 1933, Ohsava of Japan performed the first successful esophEbook Perioperative management in robotic surgery: Part 2
agectomy with an intrathoracic esophagogastric anastomosis through the left chest (9). This pioneering work was followed by similar reports from MarshChapterRobotics in Thoracic Surgery 2Benign and Malignant Esophageal DiseaseFarid GharagozlooENDOSCOPIC ROBOTIC ESOPHAGECTOMYHistorical Background“The Ebook Perioperative management in robotic surgery: Part 2phageal resection through separate laparotomy and right chest incisions with an intrathoracic anastomosis at the apex of the right chest (5). In order to avoid the consequences associated with an intrathoraclc anastomotic leak in 1972, McKeown advocated the placement of the esophagogastric anastomos Ebook Perioperative management in robotic surgery: Part 2is in the neck through a separate cervical incision after the Ivor Lewis procedure (13). It is of interest that presently the issue of intrathoracic aEbook Perioperative management in robotic surgery: Part 2
nastomotic leaks continues to dictate the approach to esophageal resections. Furthermore, it should be noted that the present controversy between the ChapterRobotics in Thoracic Surgery 2Benign and Malignant Esophageal DiseaseFarid GharagozlooENDOSCOPIC ROBOTIC ESOPHAGECTOMYHistorical Background“The Ebook Perioperative management in robotic surgery: Part 2erent approaches that were advocated throughout the twentieth century.The transhiatal approach (THA) began in 1913 when Denk demonstrated in cadavers the feasibility of blunt dissection of the esophagus by working from the neck down and up through the esophageal hiatus (14). This approach was perfor Ebook Perioperative management in robotic surgery: Part 2med by a laparotomy and a cervical incision and obviated the need for a thoracotomy. In 1933, Turner reported the first “blunt” esophagectomy followedEbook Perioperative management in robotic surgery: Part 2
by an antethoraclc skin tube reconstitution of the esophagogastric continuity (15). Ong and Lee in 1916 and LeQuesne and Ranger in 1966 reported a smChapterRobotics in Thoracic Surgery 2Benign and Malignant Esophageal DiseaseFarid GharagozlooENDOSCOPIC ROBOTIC ESOPHAGECTOMYHistorical Background“The Ebook Perioperative management in robotic surgery: Part 2ed the technique of10:36:42. subject to the Cambridge Core terms of use.0.014ChapterIZ:Rob transhiatal transcervical esophagectomy without a thoracotomy (18).EpidemiologyCancer of the esophagus is one of the most common malignancies worldwide. Approximately 13,000 new cases of esophageal cancer were Ebook Perioperative management in robotic surgery: Part 2 diagnosed in the United States in 1998. Almost 12,000 patients died within the first year (19). Presently the rate of esophageal cancers has increaseEbook Perioperative management in robotic surgery: Part 2
d dramatically. Esophageal cancer is unusual compared to other solid tumors due to the geographic variations in incidence and the cell type. Although ChapterRobotics in Thoracic Surgery 2Benign and Malignant Esophageal DiseaseFarid GharagozlooENDOSCOPIC ROBOTIC ESOPHAGECTOMYHistorical Background“The Ebook Perioperative management in robotic surgery: Part 2btype in North America (20).In 1991, Blot and colleagues examined more than 9,000 esophageal cases registered in nine National Cancer Institute surveillance, epidemiology, and end results program areas (21). They found that:1Adenocarcinoma of the lower esophagus accounted for 17 percent of primary e Ebook Perioperative management in robotic surgery: Part 2sophageal cancers overall.2From 1976 to 1987, the average rate of increase for primary esophageal adenocarcinoma exceeded that of any other cancer.3DuEbook Perioperative management in robotic surgery: Part 2
ring the last 3 years of this study, 1984-1987, adenocarcinoma accounted for 34 percent of all esophageal tumors in white males.By 1993, adenocarcinomChapterRobotics in Thoracic Surgery 2Benign and Malignant Esophageal DiseaseFarid GharagozlooENDOSCOPIC ROBOTIC ESOPHAGECTOMYHistorical Background“The Ebook Perioperative management in robotic surgery: Part 2 et al. reported a 350 percent increase in the rate of adenocarcinoma of the esophagus in white North American males from 1976 to 1994 (23).With the observation that many adenocarcinomas of the esophagus occur in association with Barretts epithelium, the metaplasia-dysplasia-carcinoma sequence has b Ebook Perioperative management in robotic surgery: Part 2een clearly demonstrated (24). Prospective studies estimate that patients with Barrett’s epithelium have at least a 30- to 40-fold higher risk for devEbook Perioperative management in robotic surgery: Part 2
elopment of invasive adenocarcinoma (25). Presently Barretts epithelium, which exhibits mutation of the P53 tumor suppressor gene, is considered premaChapterRobotics in Thoracic Surgery 2Benign and Malignant Esophageal DiseaseFarid GharagozlooENDOSCOPIC ROBOTIC ESOPHAGECTOMYHistorical Background“The Ebook Perioperative management in robotic surgery: Part 2ntly. As noted, there has been a shift from predominance of SCCA associated with tobaccoand alcohol exposure to adenocarcinoma arising in a Barrett’s esophagus as a consequence of retlux disease. In contrast to SCCA, the clearly delineated metaplasia-dysplasia-carcinoma sequence with adenocarcinoma Ebook Perioperative management in robotic surgery: Part 2provides an opportunity for early detection and better outcomes after resection.Historically the role of surgery in SCCA of the esophagus has been oneEbook Perioperative management in robotic surgery: Part 2
of palliation. The risk of surgical procedures associated with the locally advanced nature of SCCA of the mid-esophagus has prevented oncologi-cally ChapterRobotics in Thoracic Surgery 2Benign and Malignant Esophageal DiseaseFarid GharagozlooENDOSCOPIC ROBOTIC ESOPHAGECTOMYHistorical Background“The Ebook Perioperative management in robotic surgery: Part 2s more amenable to complete resection. Furthermore, recent refinements in operative technique and perioperative management have enabled greater safety in accomplishing the more efficacious en bloc tumor resection and nodal exoneration. Not only has there been a shift in the cell type and location of Ebook Perioperative management in robotic surgery: Part 2 esophageal carcinoma, there has also been a shift in the surgical approach from palliation to one with curative intent.Therapeutic StrategiesAlthoughEbook Perioperative management in robotic surgery: Part 2
surgery has been the mainstay of treatment of esophageal carcinoma, the high morbidity and mortality rates associated with surgery have necessitated ChapterRobotics in Thoracic Surgery 2Benign and Malignant Esophageal DiseaseFarid GharagozlooENDOSCOPIC ROBOTIC ESOPHAGECTOMYHistorical Background“The Ebook Perioperative management in robotic surgery: Part 2perability rate of esophageal carcinoma was 58 percent, resectability rate was 39 percent, mortality associated with resection was 29 percent, with an overall 5-year survival of 4 percent (27). In the 1980s, the resectability rate was 56 percent, mortality rate with resection was 13 percent, and 5-y Ebook Perioperative management in robotic surgery: Part 2ear survival was 10 percent (28). Presently in specialized centers that perform greater than 50 procedures per year, the mortality rate is reported atEbook Perioperative management in robotic surgery: Part 2
4.5 percent with a 5-year survival of 50.4 percent overall (29). Clearly, this dramatic change in the overall survival and operative risk is due to tChapterRobotics in Thoracic Surgery 2Benign and Malignant Esophageal DiseaseFarid GharagozlooENDOSCOPIC ROBOTIC ESOPHAGECTOMYHistorical Background“The Ebook Perioperative management in robotic surgery: Part 2rative Neoadjuvant Chemotherapy AloneThe use of preoperative chemotherapy in locally advanced esophageal carcinoma has been the subject of numerous trials. Most trials have evaluated1036:42. subject to the Cambridge Core terms : '1270.014Chapter 12: Robotics in Thoracic Surgery 2preoperative chemoth Ebook Perioperative management in robotic surgery: Part 2erapy, given for one to six cycles followed by a definitive surgical procedure (30-33). Later trials have given chemotherapy both preopera-tively andEbook Perioperative management in robotic surgery: Part 2
postoperatively. Overall preoperative chemotherapy with cisplatin-based combination therapy has achieved a major response in 17-66 percent of patientsGọi ngay
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